| NPI | 1952538381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 92181) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101248114) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2022-07-26 |